Subscribe to RSS
DOI: 10.1055/s-0030-1270843
© Georg Thieme Verlag KG Stuttgart · New York
Funktionelles und radiologisches Outcome nach ACDF bei 67 Patienten
Functional and Radiological Outcome after ACDF in 67 CasesPublication History
Publication Date:
08 April 2011 (online)
![](https://www.thieme-connect.de/media/zfo/201106/lookinside/thumbnails/10.1055-s-0030-1270843-1.jpg)
Zusammenfassung
Hintergrund und Fragestellung: Die Diskektomie mit anschließender Fusion (ACDF) wird gegenwärtig als der „Goldstandard“ zur Behandlung zervikaler Bandscheibenerkrankungen verstanden. In der vorliegenden Arbeit werden die klinischen sowie radiologischen Ergebnisse von 67 Patienten präsentiert, die sich einer ACDF unterzogen. Anhand der eigenen sowie der Ergebnisse der relevanten Literatur werden Vor- und Nachteile der ACDF analysiert sowie diskutiert und daraus resultierend Empfehlungen bezüglich des Einsatzes dieses Behandlungverfahrens formuliert. Studiendesign und Untersuchungsmethoden: Innerhalb eines Jahres unterzogen sich 67 Patienten einer ACDF. Unmittelbar prä- und postoperativ sowie 7 Monate nach dem chirurgischen Eingriff erfolgten klinische und/oder radiologische Untersuchungen. Die Ergebnisse wurden miteinander verglichen und somit der Verlauf der Untersuchungsparameter beurteilt. Ergebnisse: Das Patientenalter betrug im Durchschnitt 53 Jahre (19–81 Jahre). Im Vergleich zur präoperativen Situation zeigten sich 7 Monate postoperativ in 91 % der Fälle eine Schmerzreduktion, in 79 % ein verbessertes HWS-Bewegungsausmaß, in 78 % eine motorische Verbesserung und in 78 % eine Verbesserung der Sensibilität. Bei 85 % der Patienten zeigte sich 7 Monate postoperativ eine knöcherne Durchbauung im operierten Segment. Diskussion: Sowohl die eigenen als auch die Ergebnisse anderer Arbeitsgruppen zeigen nach ACDF positive Resultate. Über 80 % der Patienten, die sich einer ACDF unterzogen, weisen nach der Operation eine Verbesserung des neurologischen Status sowie der Schmerzsituation auf. Es handelt sich um ein etabliertes und sicheres Behandlungsverfahren, das mit einer hohen knöchernen Durchbauungsrate im operierten Segment sowie mit einer niedrigen Komplikationsrate assoziiert ist.
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is an accepted technique for the treatment of symptomatic disc disease at the cervical spine. In this study the clinical outcome of 67 patients who underwent ACDF due to cervical disc herniation are presented. Based on the results of this study and those of other working groups the pros and cons of ACDF were analysed and discussed. Methods: 67 patients with cervical disc herniation underwent ACDF of a single level. Clinical and/or radiological examination was performed immediately preoperatively, one day after surgery and 7 months postoperatively to assess the course of the examined parameters. Results: The mean age of the patients was 53 years (range: 19–81). Seven months after surgery we observed pain reduction in 91 % of the cases, range of motion in the neck improvement in 79 %, motor function improvement in 78 % and a function improvement in sensitivity in 78 % of the cases. Analysis of the CT scans 7 months after surgery showed a fusion rate of 85 % on the cervical spine segment that was treated. Discussion: The results of this study demonstrate that ACDF is an effective surgical treatment for patients suffering from disc degeneration at the cervical spine. Over 80 % of the patients showed an improved neurological status and had less pain than prior to surgery. It is a safe surgical technique with a low rate of complications and a high rate of bony consolidation on the treated level.
Schlüsselwörter
ACDF - TDR-C - Halswirbelsäule - klinisches Outcome
Key words
ACDF - TDR-C - cervical spine - clinical outcome
Literatur
- 1 Baaj A A, Uribe J S, Vale F L et al. History of cervical disc arthroplasty. Neurosurg Focus. 2009; 27 E10
- 2 Eck J C, Humphreys C, Lim T H et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine. 2002; 27 2431-2434
- 3 Chang U K, Kim D H, Lee M C et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine. 2007; 7 33-39
- 4 Galbusera F, Bellini C M, Raimondi M T et al. Cervical spine biomechanics following implantation of a disc prosthesis. Med Eng Phys. 2008; 30 1127-1133
- 5 Dmitriev A E, Cunningham B W, Hu N et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976). 2005; 30 1165-1172
- 6 Denaro V, Papalia R, Denaro L et al. Cervical spinal disc replacement. J Bone Joint Surg [Br]. 2009; 91 713-719
- 7 Cherry C. Anterior cervical discectomy and fusion for cervical disc disease. AORN J. 2002; 76 998-1004 1007-1008
- 8 Cho D Y, Liau W R, Lee W Y et al. Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery. 2002; 51 1343-1349
- 9 Kulkarni A G, Hee H T, Wong H K. Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J. 2007; 7 205-209
- 10 Lemcke J, Menz H, Al-Zain F et al. Outcome after cervical anterior fusion – a clinical study of 368 patients. Z Orthop Unfall. 2007; 145 744-752
- 11 Mastronardi L, Ducati A, Ferrante L. Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien). 2006; 148 307-312
- 12 Matgé G. Cervical cage fusion with 5 different implants: 250 cases. Acta Neurochir (Wien). 2002; 144 539-549
- 13 Beaurain J, Bernard P, Dufour T et al. Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J. 2009; 18 841-850
- 14 Heller J G, Sasso R C, Papadopoulos S M et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976). 2009; 34 101-107
- 15 Jöllenbeck B, Hahne R, Schubert A et al. Early experiences with cervical disc prostheses. Zentralbl Neurochir. 2004; 65 123-127
- 16 Mummaneni P V, Burkus J K, Haid R W et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007; 6 198-209
- 17 Murrey D, Janssen M, Delamarter R et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J. 2009; 9 275-286
- 18 Nabhan A, Ahlhelm F, Shariat K et al. The ProDisc-C prosthesis: clinical and radiological experience 1 year after surgery. Spine (Phila Pa 1976). 2007; 32 1935-1941
- 19 Sasso R C, Smucker J D, Hacker R J et al. Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech. 2007; 20 481-491
- 20 Sasso R C, Smucker J D, Hacker R J et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine (Phila Pa 1976). 2007; 32 2933-2940
- 21 Yoon D H, Yi S, Shin H C et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien). 2006; 148 943-950
- 22 Pickett G E, Sekhon L H, Sears W R et al. Complications with cervical arthroplasty. J Neurosurg Spine. 2006; 4 98-105
- 23 Riina J, Patel A, Dietz J W et al. Comparison of single-level cervical fusion and a metal-on-metal cervical disc replacement device. Am J Orthop. 2008; 37 E71-E77
- 24 Anderson P A, Sasso R C, Riew K D. Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine (Phila Pa 1976). 2008; 33 1305-1312
- 25 Nabhan A, Steudel W I, Nabhan A et al. Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants. 2007; 17 229-236
- 26 Steinmetz M P, Patel R, Traynelis V et al. Cervical disc arthroplasty compared with fusion in a workers' compensation population. Neurosurgery. 2008; 63 741-747
Dr. Christian Hessler
Neurochirurgie
Universitätsklinikum Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
Phone: 0 40/7 41 05 01 15
Fax: 0 40/7 41 03 47 49
Email: chessler@uke.uni-hamburg.de